Objective The Glasgow Coma Scale (GCS) classifies Traumatic Brain Injuries (TBI) as Mild (14–15); Moderate (9–13) or Severe (3–8). The ATLS modified this classification so that a GCS score of 13 is categorized as mild TBI. We investigated the effect of this modification on mortality prediction, comparing patients with a GCS of 13 classified as moderate TBI (Classic Model) to patients with GCS of 13 classified as mild TBI (Modified Model). Methods We selected adult TBI patients from the Pennsylvania Outcome Study database (PTOS). Logistic regressions adjusting for age, sex, cause, severity, trauma center level, comorbidities, and isolated TBI were performed. A second evaluation included the time trend of mortality. A third evaluation also included hypothermia, hypotension, mechanical ventilation, screening for drugs, and severity of TBI. Discrimination of the models was evaluated using the area under receiver operating characteristic curve (AUC). Calibration was evaluated using the Hoslmer-Lemershow goodness of fit (GOF) test. Results In the first evaluation, the AUCs were 0.922 (95 %CI, 0.917–0.926) and 0.908 (95 %CI, 0.903–0.912) for classic and modified models, respectively. Both models showed poor calibration (p<0.001). In the third evaluation, the AUCs were 0.946 (95 %CI, 0.943 – 0.949) and 0.938 (95 %CI, 0.934 –0.940) for the classic and modified models, respectively, with improvements in calibration (p=0.30 and p=0.02 for the classic and modified models, respectively). Conclusion The lack of overlap between ROC curves of both models reveals a statistically significant difference in their ability to predict mortality. The classic model demonstrated better GOF than the modified model. A GCS of 13 classified as moderate TBI in a multivariate logistic regression model performed better than a GCS of 13 classified as mild.

Aims: To determine whether the implementation of alcohol control policies was associated with changes in the incidence of road traffic deaths. Measures: Aggregated daily counts of road traffic deaths. Restrictive policies were compared with lax policies to estimate the effect of reducing hours of alcohol availability using multiple negative binomial regressions. Findings:There was a decreased risk of road traffic mortality in periods when moderately restrictive policies were in effect (IRR = 0.84, 95% CI 0.72-0.97, p = 0.019). There was an even lower risk of road traffic deaths in periods when most restrictive policies were in effect (IRR = 0.70, 95% CI 0.58-0.85, p < 0.001). In motorcyclists, most restrictive (IRR 0.55, 95% CI 0.38-0.81, p = 0.002) and full restrictive policies (IRR 0.52, 95% CI 0.29-0.94, p = 0.032) were associated with decreased risk of mortality. Conclusions:Our findings support more restrictive alcohol control policies to reduce road traffic mortality. Specifically, reducing the time of alcohol availability was associated with a decrease in road traffic death rates.